My 87-yr-old mom's pacemaker has a battery that is wearing out in approx. six months. She has had dementia for 7 years, and can't remember my name, but remembers I'm her oldest daughter and can hold her own in a conversation, complete with good advice. Both her primary Dr and the senior nurse at her ALF say any operation with anesthesia will cause her to lose a lot of cognitive memory and that it won't be recovered after the operation. Her pacemaker is used about one-third of the time, says her cardiologist, meaning her heart isn't totally dependent on the pacemaker.
My quandary: She's told me for years (long before her dementia really kicked in) that she felt she has lived too long. She has a living will. She has a DNR. She's not depressed - she's a very cheery person and is usually pretty happy, with a good sense of humor. But I'm concerned about doing anything to speed up her cognitive decline. I know doctors can keep people alive for a long time, but should they? Where does quality of life fit in? I'm my mother's POA and healthcare surrogate. My sibs have not helped with her care other than to visit her occasionally (well, 2 of the 3 have and they live very far away; the 3rd who lives 2 hrs away hasn't visited in almost 4 years). I haven't talked with them about this.
Having said that, your mother is enjoying a reasonably good quality of life, isn't she? She is usually pretty happy and cheery - no pain, no anxieties, no depression? That being so, if she does need her pacemaker battery replaced to maintain her current condition you should go ahead. It shouldn't, as far as I remember, require full anaesthesia: I should check with her cardiologists whether the sedation that would normally be used carries an acceptable risk compared with the risk of not maintaining the device.
Will it help clarify things for you if you invite your siblings to voice an opinion? In my view you have no obligation to discuss this with them, but if you feel the conversation would be useful and right, that's different.
I would suggest reading "Being Mortal" by Atul Gawande before making the decision. Only because it helped me, and maybe it will help you.
My uncle had had dementia and bowel cancer that had spread. I took the decision that he would be confused and unhappy in hospital having treatment and arranged pain relief palliative care . Despite being told he’d only have weeks - he enjoyed a further 15 months stress free mostly happy without medical intervention.
Do what feels right for your mum - I wish you both the best
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Good luck!
My mom has a DNR. we decided not to have a pacemaker put in for my mom (she’s 90 with Alzheimers) It was the hardest decision of my life but I know it’s the right one.
Based on what you have said, if I were in your shoes, HONESTLY I would not have the procedure done.
Also, do NOT discuss it with the siblings. Do NOT.
It will not end well.
she cannot talk or walk. last year she need a new battery for her pacemaker
so I had the same question what to do, the doctor told me the cost would be
zero, I made my decision as follows she is not a angry person and all other
organs were working fine. her only thing in life is the TV so I elected to have
the new bat put in. ooppppps after all that was said and do it cost me after
insurance $1500 far cry from zero.
So, schedule the procedure. Take a list of questions for all doctors. If several doctors are not giving you good chances for positive outcomes, then it might be better to let nature take its course. My bet is that mom will do fine... and I was a critical care RN for many years.
Not telling the siblings will open a whole new can of worms later on and you'll be dealing with potential guilt trips - and only you know how you deal with guilt.
After reading the book, I realized that I don't want to prolong my life if I am in any stage of dementia. I'd rather not live through the fear and confusion. If mom has a DNR, she's ready to go. Why take the chance that the quality of her life will be lower after the surgery? The battery will slowly wear out, but it will continue to give her those horrible shocks to get the heart back in rhythm. Instead of changing the battery, I'd be turning it off in a painless, anesthetic free procedure involving a magnet at the hospital, with that DNR all over the room.